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HomeMy WebLinkAboutPlumbing Permit 15. 1433 I 0o n 000000 13 0 > §2 n n 7 0 00 co 71 0 � � % mm m z z 0 Of -I-a % t � q 2 m - Q-1Q P Z- , . § § ca . z 0 xi k ). 0 nz- z mm m 0 a § 7 m q r VI m 0 k k z xj oo 000000 k \ § D m § 1§m2 § & ? m q § §§ I § M n co $ q ; q >° ooC) q § q 2 0 0 r -n22 m o 0 0 CO r§ -a P a ■ 0 x m g n k00000 - N § ' , Q :n. iin§ @ § ° k --0 '0 ® ' . m �z% mC i 11 § § tM■ -4 / - + §r 0 O� YRtp� Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT / 12S ' (S 4 �� I.B2.Gold ie t ,,,/// City PERMIT NO. J B 3.Yellow ACpApplicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID IV' LD&`f' O(Name) D /1/Pri (Phone) (Address) APPLICANT ,� IVE. �r (Name) 4j WI/ t-�-�L� � (Phone) l 2 Q W ©-(0"l (Address) ,Ti V (3 .tbe, - Y i „' � �2+a ,411\ �U 2 � ) (Address) (City) (Zip Code) S (J (Contact Person) 61,54-k___ (Phone) /i 12 APPLICANT SIGNATURE G`Vi'�t � L DATE l /-7 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher Water Heater Floor Drain I Water Softener Lavatory(Bathroom Sink) Stand Pipe(Washing Machine) Laundry Tray(1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet(Toilet) Other FEE SCHEDULE Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 Residential,Additions&Alterations $49.50 Estimated Cost $ Building Permit# PLUMBING PERMIT FEE $ SO STATE SURCHARGE $ TOTAL PERMIT FEE $ ) 567 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid SD E;73 Receipt No. Date . t rs- By SvL"�/ Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372